Crime Problem · Medicaid Fraud · May 8, 2026 · Live

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Waste of the Day: Autism Medicaid Misspending.
The Federal Government Billed $200 Million in Fraud to America’s Most Vulnerable Families.

• $198M+improper paymentsHHS OIG audited 4 of 7 planned states — Indiana, Wisconsin, Maine, Colorado — 2019–2024
• 100%of sampled claimsEvery single enrollee-month sampled across all four states included at least one improper or potentially improper payment
• 7 statesin the seriesHHS OIG launched the audit series in January 2022 — only 4 complete; 3 more states pending
• $123Mfederal refund owedOIG recommended combined repayment to federal government — no state has repaid in 4 years

The U.S. Department of Health and Human Services Office of Inspector General has been auditing Medicaid payments for Applied Behavior Analysis (ABA) therapy — the primary evidence-based treatment for children with autism spectrum disorder — since January 2022. Four states audited. Nearly $200 million in improper or potentially improper payments found. One hundred percent of sampled claims in every state included at least one billing violation. The OIG has told those four states to return a combined $123 million to the federal government. Not one state has done so in four years.

The fraud pattern is consistent across states and not subtle. Providers billed for therapy sessions that never occurred. They submitted claims for patients who had already terminated services, for holidays when no one was in the office, and for hours that vastly exceeded any plausible human schedule. In Indiana, one provider — Piece by Piece Autism Centers — received $29 million in 2023 to treat just 84 patients, billing as high as $640 per hour for therapy that typically costs $61 nationally. The state eventually barred the company from Medicaid billing, but only after years of unrestricted payments.

The consequence is not just financial. When Medicaid dollars flood into a program with no documentation requirements enforced, the patients who need the service most get buried under the noise. Families fighting to access legitimate ABA therapy for their autistic children compete with ghost patients and paper clinics for limited slots. This is what it looks like when a federal program runs without accountability: the money flows, the oversight fails, and the fraud calcifies into the rate schedule.

Applied Behavior Analysis is a legitimate, federally recognized therapy. Under Medicaid, states are required to cover ABA for children diagnosed with autism following the Erin Merryn Law (2012 CMS guidance) interpretation, and the market expanded rapidly after all 50 states mandated insurance coverage by 2019. Medicaid ABA spending in Indiana alone grew from $14.4 million in 2017 to $101.8 million by 2020 — a 607 percent increase in three years, second highest in the country at the time.

That rate of growth is a flare. The OIG's audit methodology is simple: pull a sample of claims, request supporting documentation (session notes, therapist credentials, supervision logs, patient diagnosis records), and check whether the documentation matches the billing. Across Indiana, Wisconsin, Maine, and Colorado, auditors found the same failure in every sample: providers could not produce records proving therapy occurred. Claims were submitted for services not rendered, dates of service that were holidays or weekends, patients who had formally terminated services, and hours that exceeded 24 in a single day for a single patient. That last finding — a provider billing more hours than exist in a day — is not an oversight. It is fabrication.

The Wall Street Journal reported on March 10, 2026, that Indiana had barred Piece by Piece Autism Centers, owned by Meghann Mitchell, from Medicaid billing after the state's review found billing rates as high as $640 per hour for services the national market delivers at a median of roughly $61 per hour. In 2023, the company received $29 million in Medicaid payments for 84 patients — approximately $345,000 per child for the year.

Mitchell told the Journal that her company complied with Indiana's rules and that state regulators never objected to the rates she charged. That statement is its own indictment of the oversight infrastructure: a provider billing at 10 times the national rate, for years, without a single state inquiry, until a federal watchdog and a national newspaper made the number impossible to ignore.

“ABA therapy was an area of behavioral health where fraud and abuse is rampant. We were often seeing fraud warranting criminal charges, most often in cases where providers were billing for services that were never actually provided to patients.”

Kevin Lownds, Division Chief — Massachusetts Medicaid Fraud Control Unit · 2025

Medicaid is jointly administered: the federal government sets the rules and provides the match; states administer the program and make the payments. The OIG's audits found improper payments during specific administrations. The political record:

Colorado — governed by Gov. Jared Polis (D)throughout the 2022–2023 audit period. Colorado's Medicaid ABA spending grew from $60.1 million in 2019 to $163.5 million by 2023 — a 172 percent increase in four years — with zero effective claims-review infrastructure, per the OIG. Maine — governed by Gov. Janet Mills (D) during the audit period. Wisconsin — governed by Gov. Tony Evers (D) during the audit period. Indiana— a Republican-led state, but the federal match means federal dollars fund the fraud regardless of which party administers the program; Indiana's oversight failure under multiple administrations is documented.

Federal Medicaid oversight rests with the Centers for Medicare and Medicaid Services (CMS), housed within HHS. During the 2019–2023 audit period, CMS was led under the Biden administration by Administrator Chiquita Brooks-LaSure (D) and HHS Secretary Xavier Becerra (D). The OIG — the watchdog — is a separate office, and it did its job. The question is why CMS, which writes the checks, did not trigger reviews on its own when ABA spending grew by triple digits in multiple states simultaneously.

The OIG audits measure billing noncompliance — they do not require criminal intent. The criminal docket is being built separately, and Minnesota is the leading edge.

In September 2025, federal prosecutors in Minnesota charged Asha Farhan Hassan, 28, with wire fraud for her alleged role in a $14 million scheme to defraud Minnesota's Early Intensive Developmental Behavioral Intervention (EIDBI) program — the state's autism-specific Medicaid service. She pleaded guilty. Abdinajib Hassan Yussuf, 27, was separately charged with leading a scheme through Star Autism Center LLC in which his company recruited children from the Somali community — sometimes helping children without an autism diagnosis qualify for services — and paid parents cash kickbacksto enroll their children. Unqualified relatives were hired as “behavioral technicians” and fraudulent claims were submitted resulting in over $6 million in reimbursement funds. By December 2025, federal and state officials announced six additional defendants charged across the EIDBI program.

Applied Behavior Analysis, when delivered by qualified providers to children with autism spectrum disorder, has decades of peer-reviewed evidence behind it. Early, intensive ABA — 25 to 40 hours per week for children under 5 — is associated with significant improvements in language, adaptive behavior, and long-term independence. Medicaid was right to cover it.

The fraud machine corrodes that system at both ends. For families waiting for legitimate services, fraudulent providers consume the available slots and push rates so high that compliant providers struggle to compete. For the children enrolled in fraudulent programs — including children in Minnesota who were recruited to front fraudulent clinics and may never have received a single hour of real therapy — the Medicaid record shows “services rendered.” They age out of the early-intervention window. The developmental window closes. The fraud becomes, for those children, a life sentence.

“The four audits include the same compliance failures — auditors repeatedly found that providers could not produce records proving therapy occurred — suggesting the problem is structural to the Medicaid ABA program, not isolated misconduct.”

HHS OIG Audit Series Finding — Indiana, Wisconsin, Maine, Colorado · 2024–2026

Three states remain in the OIG's seven-state audit series. None have been identified publicly yet; the work plan designates them as SRS-A-25-029. The U.S. House Energy and Commerce Committee has opened probes into ABA billing in at least ten additional states, per the OIG enforcement record. Indiana enacted lower reimbursement rates in 2024 under then-Gov. Eric Holcomb (R) and is implementing a 4,000-hour lifetime service cap under Gov. Mike Braun (R), who took office in January 2025. Colorado, Maine, and Wisconsin — all Democratic-governed — have not publicly announced equivalent corrective actions as of May 2026.

Massachusetts is pursuing criminal charges. Minnesota has charged 14 defendants and is still counting. The Massachusetts AG's indictment of Patrice Lamour and her Randolph-based companies — for allegedly billing MassHealth more than $1 million for services never provided, including on holidays and after patients had canceled — is a template for what systemic prosecution of this pattern looks like. The OIG audits built the paper trail. The question is whether federal and state prosecutors pick it up.